The common features of walking in patients with stroke include decreased gait velocity and increased asymmetrical gait pattern. The purpose of this study was to identify important factors related to impairments in gait velocity and asymmetry in chronic stroke patients. The subjects were 30 independently ambulating subjects with chronic stroke. The subjects' impairments were examined, including the isokinetic peak torque of knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors. Passive and active ranges of motion (ROM) of the ankle joint, ankle plantarflexor spasticity, joint position senses of the knee and ankle joint, and balance were examined together. In addition, gait velocity and temporal and spatial asymmetry were evaluated with subjects walking at their comfortable speed. Pearson correlations and multiple regressions were used to measure the relationships between impairments and gait speed and impairments and asymmetry. Regression analyses revealed that ankle passive ROM and peak torque of knee flexors were important factors for gait velocity ($R^2=.41$), while ankle passive ROM was the most important determinant for temporal asymmetry ($R^2=.35$). In addition, knee extensor peak torque was the most significant factor for gait spatial asymmetry ($R^2=.17$). Limitation in ankle passive ROM and weakness of the knee flexor were major contributors to slow gait velocity. Moreover, limited passive ROM in the ankle influenced the level of temporal gait asymmetry in chronic stroke patients. Our findings suggest that stroke rehabilitation programs aiming to improve gait velocity and temporal asymmetry should include stretching exercise for the ankle joint.
Bijleveld-Uitman M, van de Port I, Kwakkel G. Is gait speed or walking distance a better predictor for community walking after stroke? J Rehabil Med. 2013;45(6):535-540. http://dx.doi.org/10.2340/16501977-1147
Bilney B, Morris M, Webster K. Concurrent related validity of the gaitrite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture. 2003;17(1):68-74.
Bohannon RW, Andrews AW. Correlation of knee extensor muscle torque and spasticity with gait speed in patients with stroke. Arch Phys Med Rehabil. 1990;71(5):330-333.
Bohannon RW, Andrews AW, Smith MB. Rehabilitation goals of patients with hemiplegia. Int J Rehabil Res. 1988;11(2):181-184.
Bohannon RW, Walsh S. Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke. Arch Phys Med Rehabil. 1992;73(8):721-725.
Davis RB, Deluca PA. Gait characterization via dynamic joint stiffness. Gait Posture. 1996;4(3):224-231.
De Quervain IA, Simon SR, Leurgans S, et al. Gait pattern in the early recovery period after stroke. J Bone Joint Surg Am. 1996;78(10):1506-1514.
Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987;66(2):77-90.
Flansbjer UB, Downham D, Lexell J. Knee muscle strength, gait performance, and perceived participation after stroke. Arch Phys Med Rehabil. 2006;87(7):974-980.
Friedman PJ. Spatial neglect in acute stroke: The line bisection test. Scand J Rehabil Med. 1990;22 (2):101-106.
Gao F, Grant TH, Roth EJ, et al. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. Arch Phys Med Rehabil 2009;90(5):819-826. http://dx.doi.org/10.1016/j.apmr.2008.11.004
Holden MK, Gill KM, Magliozzi MR, et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984; 64(1):35-40.
Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil. 2003;84(8): 1185-1193.
Jorgensen HS, Nakayama H, Raaschou HO, et al. Recovery of walking function in stroke patients: The copenhagen stroke study. Arch Phys Med Rehabil. 1995;76(1):27-32.
Kim CM, Eng JJ. The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther. 2003;83(1):49-57.
Knutsson E. Gait control in hemiparesis. Scand J Rehabil Med. 1981;13(2-3):101-108.
Ko SU, Stenholm S, Metter EJ, et al. Age-associated gait patterns and the role of lower extremity strength-results from the baltimore longitudinal study of aging. Arch Gerontol Geriatr. 2012;55 (2):474-479. http://dx.doi.org/10.1016/j.archger.2012.04.004
Lin PY, Yang YR, Cheng SJ, et al. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-568.
Lin SI. Motor function and joint position sense in relation to gait performance in chronic stroke patients. Arch Phys Med Rehabil. 2005;86(2): 197-203.
Menz HB, Latt MD, Tiedemann A, et al. Reliability of the gaitrite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture. 2004;20(1): 20-25.
Nadeau S, Arsenault AB, Gravel D, et al. Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil. 1999;78(2):123-130.
Nasciutti-Prudente C, Oliveira FG, Houri SF, et al. Relationships between muscular torque and gait speed in chronic hemiparetic subjects. Disabil Rehabil. 2009;31(2):103-108. http://dx.doi.org/10.1080/09638280701818055
Olney SJ, Griffin MP, Monga TN, et al. Work and power in gait of stroke patients. Arch Phys Med Rehabil. 1991;72(5):309-314.
Sekir U, Yildiz Y, Hazneci B, et al. Reliability of a functional test battery evaluating functionality, proprioception, and strength in recreational athletes with functional ankle instability. Eur J Phys Rehabil Med. 2008;44(4):407-415.
Suzuki K, Imada G, Iwaya T, et al. Determinants and predictors of the maximum walking speed during computer-assisted gait training in hemiparetic stroke patients. Arch Phys Med Rehabil. 1999;80(2):179-182.